Cross of Gold

Like most people, I was surprised and puzzled by Joe Biden's condition on Thursday night. Maybe he had taken a cold medication, but if a shot of Vicks will do that to him he's got a problem. Of course, the conventional wisdom that being out of it is worse than spewing nonstop lies seems askew, but that's where we are. Nobody care what I think but yeah, Biden should drop out.

There are very good reasons why the clinical trials process I just described is required to get FDA approval for new drugs (or procedures, but we're sticking with drugs for now to keep it simple). I shouldn't have to tell y'all about the Thalidomide catastrophe, and even if it doesn't outright kill people or cause horrific birth defects, a pill that just doesn't work is a) going to waste a lot of money and b) stop people from taking one that does work. However . . . .

New drug development, like everything else that goes on in the medical industry, is not driven by humanitarian objectives, but by profit. Which means, ipso facto, that the drug companies are going to make their decisions about those big investments based on their best guesses about how they can make the most profit. And the profit in drugs comes in large part from patent protection and exclusive marketing rights -- if you can sell it with no competition, you can charge big bucks. This has several unfortunate consequences. e.g.:

• There's little or no money to be made in showing that a product that is already on the market and can't be patented has a previously unproven use. So there may be a lot of beneficial uses out there that we just don't know about. Same goes for products of nature.

• There's a lot more money to be made from something people have to keep taking for a long time than there is from something that you only take once, or a for a few days. That's why, for example, there's been little investment in new antibiotics, though they are sorely needed.

 

• There's little money to be made from products that treat rare diseases. There are incentives for developing these "orphan drugs," but that doesn't fully overcome the distortion that favors more common conditions.

• There's a lot of money to be made from products that treat people who are facing imminent death, for which society will countenance enormous expense. New cancer treatments typically cost $100,000 or two or three times as much, but they typically offer only very modest extension of life. Products that improve quality of life for larger numbers of people, or extend life in the long run but don't stave off imminent death, won't withstand such high prices. That's a feature of a quirk of human psychology called the Rule of Rescue, which I'll talk about more anon.

So, we really need a different way of financing new drug development, and of deciding what we're willing to pay for.